HHS Gives Waivers to Two More States; Effort to Boost Primary Care Options in Danger


HHS Gives Waivers to Two More States; Effort to Boost Primary Care Options in Danger

Monday, May 16th, 2011 - 14:41
Monday, May 16, 2011 - 13:48
The Obama administration has granted two additional states a waiver to slow down their implementation of medical loss ratio requirements. An effort to boost primary care is caught in a political showdown.

The Department of Health and Human Services has granted Nevada and New Hampshire waivers allowing them to meet medical loss ratio requirements on a more gradual basis, according to The Hill. This brings the number of states that have been granted such waivers to three, with Maine recently receiving a waiver.

Under the medical loss ratio requirement in health reform, insurers must spend at least 80 percent of the premium dollars they collect on expenditures related to medical care. Insurers in some states -- and officials in those state -- have argued that ramping up immediately to the requirement could destabilize insurance markets and leave people with few, if any, options for coverage.

HHS has agreed that the MLR would be too difficult for Nevada and New Hampshire to meet in the short term. In New Hampshire, insurers will have to meet a 72 percent requirement this year and a 75 percent requirement in 2012. Insurers will have to meet the original requirement in 2013. Insurers in Nevada will get a one-year reprieve to meet a 75 percent threshold.

In other news, The Washington Post reports that a commission designed to help boost the primary care workforce to meet heavy demand under health reform's expansion in coverage has been unable to do any work because its appropriation is tied up under congressional squabbling. The National Health Care Workforce Commission is tasked with coming up with solutions for the government and medical schools to increase the pipeline of primary care doctors.

The coming primary care crunch is an especially thorny problem for Medicaid, which is expected to absorb roughly half of the 32 million people expected to gain coverage under health reform. As provider reimbursement rates have dropped in recent years, fewer and fewer doctors have been willing to see Medicaid patients.

There has also been a general trend in health care that has seen more and more medical school graduates go into specialized medicine because of divergent salary opportunities for specialists and primary doctors.

Both of these examples are further indications that the implementing the health law is arguably a greater challenge than writing it and getting it passed.